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Correction of the double eyelid line in sunken eyelids

Sunken upper eyelids

When the eyelids are sunken, they are sometimes corrected with fat grafting instead of revision surgery.

Micro fat grafting to correct an awkward double eyelid line

When the upper eyelids are sunken and the double eyelid line looks awkward, in some cases it can be corrected sufficiently with micro fat grafting alone without the need for an incision.

If surgery is performed on a sunken double eyelid condition, the double eyelid line cannot be properly formed, and even if surgery is done, unsatisfactory results are likely because of the sunken contour.

In cases with sunken upper eyelids, it is best to first perform fat grafting to correct the sunken area while adjusting the double eyelid shape at the same time.

Effects of correcting the double eyelid line with micro fat grafting in the upper eyelid

① Correction of thick double eyelid lines

② Correction of loosened double eyelid lines

③ Correction of asymmetrical double eyelid lines

④ Correction of triple double eyelid lines

⑤ Correction of multiple wrinkle lines

⑥ Restoration of lost lines

Anatomy of orbital fat in the upper eyelid

Role of orbital fat

① It gives the eyelid contour volume and softness.

② It protects the eyeball from external impact.

③ It acts as a lubricant so the levator palpebrae superioris muscle (the muscle that lifts the eyelid) can move smoothly.

Effects obtained through micro fat grafting in the upper eyelid

Aesthetic aspect

① Recovery to a softer, younger-looking eye shape by correcting the sunken area

② Correcting an awkward double eyelid line

Functional aspect

It helps the levator palpebrae superioris muscle, which opens the eyes, move more smoothly and reduces eyelid fatigue.

Placement of micro fat grafting in the upper eyelid

The goal of upper eyelid fat grafting must be to satisfy both aesthetic and functional purposes.

For this, it is absolutely important to transplant the appropriate amount of fat into the exact location.

The most accurate location for fat grafting is where orbital fat is located,

and the newly transplanted fat should blend with the existing fat in that area to achieve good results.

However, if it is transplanted incorrectly into the orbicularis oculi muscle layer, the eyelid can become lumpy and, rather than improving, the eye may feel heavier and opening it may become more uncomfortable.

Therefore, upper eyelid fat grafting must be performed delicately with precise anatomical knowledge in order to achieve the desired result.

Fat grafting procedure for attractive eye shape

Example of correcting a thick double eyelid line with micro fat grafting

This is applied only when the upper eyelid is sunken,

and micro fat grafting requires highly skilled technique and know-how, as well as accurate knowledge of eyelid anatomy.

Therefore, eyelid fat grafting can be performed properly only by someone with extensive experience in double eyelid revision surgery.

Because it is a very high-level procedure that must also consider correction of sunken eyelids and awkward double eyelid lines,

it is better not to undergo the procedure from someone with insufficient experience or a non-specialist in plastic surgery.

Example of correcting an asymmetrical double eyelid line with micro fat grafting

When the eyelid becomes sunken because there is insufficient orbital fat, the line is pulled upward and becomes larger.

In such cases, it can be simply corrected with micro fat grafting without revision surgery.

Micro fat grafting is a simple procedure in which fat is injected with a syringe.

Example of correcting a loosened double eyelid line with micro fat grafting

When the eyelid becomes sunken and the line is pulled upward and loosens, the sunken eyelid and the loosened line can be corrected with micro fat grafting.

However, this applies only when the cause of loosening is solely the sunken eyelid,

and the main purpose of the procedure is to correct the sunken eyelid, with correction of the double eyelid line being a secondary purpose.

If the line does not naturally return even after the eyelid is restored, revision surgery must be performed.

Example of correcting triple double eyelid lines with micro fat grafting

When the eyelid becomes sunken, the skin may be pulled upward, making the line larger or creating a triple double eyelid.

Sometimes multiple layers of wrinkles also form.

In such cases as well, it can be easily corrected with micro fat grafting.

Two-dimensional flat fat grafting for the upper eyelid

Upper eyelid fat grafting should be performed as two-dimensional flat fat grafting.

If fat is grafted under the skin, problems such as a heavier eyelid and uneven skin can occur.

To avoid these side effects, the fat must be transplanted accurately between the orbicularis oculi muscle and the levator palpebrae superioris muscle,

and this requires precise anatomical knowledge and extensive experience.

Fat grafting must be performed in the exact location to achieve a complete result both functionally and aesthetically.

Recovery period after micro fat grafting in the upper eyelid

Usually, normal activities are possible right away.

There will be some swelling and bruising, but it is usually mild enough to be covered with makeup, so it does not significantly affect daily life.

However, swelling and bruising vary from person to person, so not every case is the same,

but on average, severe swelling and bruising do not occur, and it usually becomes much more natural after about a week.

Number of micro fat grafting sessions for the upper eyelid

The survival rate of eyelid fat grafting is relatively high compared with other areas.

With one to two sessions at most, satisfactory results can usually be achieved.

The interval between procedures is between 3 and 10 months, and when repeating the procedure, the fat that was harvested and stored at the time of the first fat grafting is thawed and used.

However, in many cases, one procedure is enough and a second one is not necessary.

Since the fat survival rate varies from person to person, the decision on whether to do a second procedure should be made at least 3 months later.

Fat graft survival and survival rate

The survival rate of fat cells differs by area of the face.

The higher the survival rate, the fewer the procedures needed and the greater the effect.

For example, a survival rate of 80% means that 80% of the total transplanted fat survives and 20% is absorbed and disappears.

Therefore, the higher the survival rate, the better the result.

Areas with a low survival rate include the lips, and the area with the highest survival rate is around the eyes.

The average survival rate after fat grafting is 50%.

That is, after grafting 100 units of fat, only 50% remains after several months.

The better the blood circulation, the higher the fat survival rate, and because the area around the eyes has the best blood circulation among facial areas, the survival rate is higher there than in other areas after fat grafting.

Therefore, around the eyes, a permanent effect can be achieved with just one procedure.

However, since repeat procedures are sometimes needed, it is better to think of fat grafting as a treatment that may be done about twice.

Second fat grafting procedure and fat harvesting

When fat is harvested from the lower abdomen or thighs, enough fat is collected for grafting, and the remaining fat is not discarded but stored sterilized in a freezer.

The stored fat can be kept for about 10 months, so if you visit within 10 months,

you can receive an additional procedure without harvesting more fat.

Whether the fat is stored or harvested and used immediately, the result is the same.

Lasting effects of micro fat grafting in the upper eyelid

After fat grafting, as the fat is absorbed over 3 to as long as 6 months, the volume decreases.

Afterward, once the fat has fully survived and no further absorption occurs, the remaining fat stays permanently.

The surviving fat does not melt away on its own.

If body weight decreases overall in the future, the grafted area may be affected, but if body weight remains the same, the volume of the grafted area changes very little.

Therefore, the surviving fat remains as the person’s own tissue for life.

That does not mean the shape will remain the same forever.

As people age, their skeleton changes, wrinkles develop in the eyelids, the skin sags, and weight may decrease, so the shape of the fat-grafted area will not remain exactly the same.

Until aging progresses significantly, however, the effect lasts continuously.

That is why the term “semi-permanent” is used.

Side effects of micro fat grafting in the upper eyelid

The side effects are limited to mild swelling and bruising.

Other side effects can be considered nonexistent.

Because the procedure uses the patient’s own fat rather than a foreign substance, there is no immune rejection or inflammation.

Also, once the fat survives, it is no longer absorbed and becomes the patient’s own tissue.

In some cases, patients experience side effects after undergoing the procedure at a clinic with somewhat limited fat grafting experience, but this is an issue related to the practitioner’s skill.

If the fat is transplanted into the orbicularis oculi muscle layer rather than the orbital fat layer, the eyelid may become heavier and lumpy; if too much fat is injected, the eyelid may swell and make daily life difficult; if excessive fat injection causes ptosis and the eye does not open well; or if much of the fat is absorbed, the effect may not be seen.

Because results differ from clinic to clinic, it is better not to receive the procedure from a plastic surgeon who lacks sufficient experience in fat grafting.

Other treatment methods besides fat grafting

So far, there is no other method for correcting sunken upper eyelids besides fat grafting.

In some cases, an incision is made in the upper eyelid and a lump of fat is transplanted as if doing double eyelid surgery, but this creates the burden of needing an incision,

and transplanting a lump of fat can cause the eyelid to become heavier.

In addition, although various fillers used in plastic surgery (Restylane, Artecoll, Juvederm) are widely marketed and used,

injecting commercial fillers into the upper eyelid may cause the eyelid to become stiff and make opening the eyes uncomfortable, and inflammation may occur.

Therefore, micro fat grafting using the patient’s own tissue is a safe and effective treatment method.

Common questions and answers about micro fat grafting in the upper eyelid

Is it true that eyelid fat grafting has many side effects, so it should not be done at other clinics?

It is not true that all other clinics are like that.

The areas that require the highest level of experience and skill in fat grafting are the upper eyelid and under-eye dark circle fat grafting.

These are areas where the procedure cannot be performed carelessly without accumulated experience and skill.

We always say in the consultation room that fat grafting is absolutely not a procedure that just anyone can do.

As with all surgeries, the results vary depending on the surgeon’s experience and know-how.

Although many clinics perform fat grafting, only a handful do it properly.

It is easy to perform, but difficult to achieve proper results.

In principle, good results can be achieved only when fat grafting is performed accurately.

Each clinic uses a different technique, and the results vary greatly depending on experience.

You may have a bad impression after experiencing or hearing about improper fat grafting, but if it is done correctly, satisfactory results can be achieved with just one procedure.

In particular, the upper eyelid area (sunken eyelids, sunken eyelids) requires extensive experience, skill, delicacy, and precision, so not just anyone can perform it.

I had eyelid fat grafting at another clinic, but almost everything has gone away. Can it be done again in such a case?

Even after treatment at another clinic, if the fat survival rate was low and it has almost disappeared, repeat treatment is still possible.

However, it must be done at least 3 months later.

Because the fat graft survival period takes at least 3 months, another procedure can be done once 3 months have passed since the last one.

Even if it is repeated at our clinic, the result is almost the same as the first procedure.

I had eyelid fat grafting at another clinic, and it is uneven and uncomfortable when opening my eyes. Is this a side effect?

The goal of eyelid fat grafting is to restore sunken eyelids and functionally improve the ability to open the eyes, reducing eye fatigue.

To achieve these goals, the procedure must be done accurately and delicately.

With fat grafting performed by someone with somewhat limited experience, problems may occur, such as unevenness from grafting into the orbicularis oculi muscle layer rather than the orbital fat layer, or discomfort opening the eyes compared with before the procedure if fat is grafted near the deep levator palpebrae superioris layer.

If such side effects occur, the fat must be removed again, which is quite difficult.

To prevent side effects, it is better not to undergo the procedure from someone with limited experience or a non-specialist in plastic surgery.

What if filler is injected into the eyelid instead of fat grafting?

Because the eyelid is a structure that moves constantly, procedures that interfere with eyelid movement should not be performed.

Fat grafting provides a cushioning and lubricating role that helps eyelid movement become smoother, but if a foreign substance such as filler is injected, it can seriously impair the function of opening the eyes apart from the appearance of the eyelid, and in severe cases, swelling of the eyelid may not go down or the eye shape may become distorted.

Inflammation can even occur, so fillers should absolutely not be injected into the eyelid.

Is eyelid fat grafting dangerous because it is close to the eyeball?

Not at all.

The risk is high when the procedure is performed by a doctor with somewhat limited experience or a non-specialist in plastic surgery, but if an experienced specialist performs the procedure accurately, there is no need to worry.

Eyelid fat grafting must be performed by someone who has precise anatomical knowledge and know-how gained through extensive experience with double eyelid surgery, and if done according to principle and accurately, it is one of the safe procedures.

I had eyelid fat grafting at another clinic, and it became puffy. Can it be corrected?

Sometimes, after excessive fat injection at another clinic, the eyelid becomes heavier and puffy, and patients come to our clinic for correction.

Depending on the condition, the fat needs to be suctioned and removed. If the fat lump can be grasped by hand, it can be corrected by inserting a microcannula and suctioning it out.

However, 100% removal is impossible, and usually about 50–80% can be removed by suction to correct it.

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